Wednesday, June 12, 2013

Guest Post: The myth of unrestricted pharmaceutical grants

A free clinical monograph from the American Academy of Family Physicians on "Diagnosis and Management of Obesity," sponsored by an educational grant from VIVUS, Inc. (manufacturer of the prescription weight-loss drug Qsymia) has stirred controversy about the financial relationships of the AAFP (which, full disclosure, pays me to provide independent editorial and consulting services for their journals American Family Physician and Family Practice Management). I received a copy of the obesity monograph and patient education materials in my clinical office but have been unable to find it online. Although this is hardly the first time that the AAFP has sought questionable commercial sponsorship for educational material (see my previous blog post about its agreement with Coca-Cola), the timing of this monograph's publication and a renewed sales push for the thus-far-disappointing diet drug is unlikely to be coincidental.

The usual defense of such medical-industry relationships goes as follows: the drug manufacturer provided an "unrestricted" educational grant and had no influence over the content, other than that it had to be about a certain topic (in this case, management of obesity). So why not accept this funding with no strings attached to produce unbiased clinical content for one's member physicians? In fact, why shouldn't a medical specialty society such as the AAFP seek funding from multiple competing drug companies to reduce the chance that its educational offerings will be biased one way or another? Dr. Jerome Hoffman strongly disagrees in his guest post below.


It is possible that when Ford Motor Company puts out a brochure comparing mid-sized SUVs that it contains some "educational material," but this is hardly guaranteed! Same for this; it's possible they include some other stuff that is factual, in order to dress up the advertisement -- but neither is this guaranteed ... nor even relevant. Or if Ford paid Car and Driver to publish an "educational review" of auto companies, would you say, "Let's read it to see if it's fair before we presume to imagine it might be biased"? Of course if Ford assured us the funding was "an unrestricted grant," and the paid authors assured us they had no conflicts of interest -- well, OK, then I take it all back.

What if a law firm gave an unrestricted grant to a judge, to write an educational review of the firm's pending case before him? No worries, especially if the judge denies any conflicts.

I say that all those unrestricted grants corporations give to politicians (who certainly never fail to put the public interest first) don't ever buy influence, but merely "access."  When Enron gives millions to candidates on all sides, they're giving away their money merely as a generous public service ... just as the scientific monographs that they sponsor -- all written by non-conflicted authors (or ghostwriters) -- are simply attempts to educate us. Heaven forbid we prejudge them.

Excuse me, but Pharma doesn't throw away its money. There is no such thing as an unrestricted grant; if it didn't buy value in return, why would they pay for it? And if the author didn't write something they like to read, do you think he'd ever get another unrestricted grant?

Finally, I don't believe it's actually about favoring one company over another; it's about favoring them all. They may compete over certain individual drugs, but they all thrive when "Key Opinion Leaders" (and our "independent" societies, and journals, and universities) help doctors, and the public, buy into the myth about wonder drugs (for sexual performance, for weight loss, etc.) ... at a cost of many many billions to all of us. That's why their extremely active lobbying trade group (PhRMA) represents all of them together.